The etabolic response to injury,whether a controlled electivesurgical procedure or an accidental injury,is characterized by the breakdown of skeletal muscle protein and the translocation of the amino acids to visceral...The etabolic response to injury,whether a controlled electivesurgical procedure or an accidental injury,is characterized by the breakdown of skeletal muscle protein and the translocation of the amino acids to visceral organs and the wound.At these sites the substrate serves to dnhance host defenses,and support vital organ function and wound repair.Glutamine (GLN) plays a major role in this process,accounting for approximately one-third of the translocated nitrogen.From the data available,GLN supplemented intravenous nutrition in patients undergoing elective surgery improved nitrogen balance,helped correct the decreased GLN concentration found in the free intracellular skeletal muscle amino acid pool and enhanced net protein synthesis (particularly in skeletal muscel).Six rancomized blinded trials(two multicentered investigations) have reported a dereased length in hospital stay in postoperative patients receiving GLN supplementation.Following blunt trauma,GLN supplementation increased plasma concentrations,attenuated the immunosuppression commonly observed and decreased the rate of infection.Patients with burn injury have low GLN plasma and intramuscular concentrations,but turnover and synthesis rate are accelerated,yet apparently inadequate to support normal concentrations.These data suggests that GLN supplementation has important effects in catabolic surgical patients,but the exact mechanisms to explain these events remain unknown and more research is required to explain the apparent benefits of dietary GLN.展开更多
Recent trends suggest that clinicians should use evidencegenerated by sound scientific studies in the treatment of patients.This field of clinical epidemiology has been formalized and is referred to as evidence based ...Recent trends suggest that clinicians should use evidencegenerated by sound scientific studies in the treatment of patients.This field of clinical epidemiology has been formalized and is referred to as evidence based medicine.Recommendations from this field urge practitioners to use the best evidence available to make clinical decisions;category A veidence is from large well-performed randomized trials,category B evidence comes from smaller trials or from meta-analysis and category C evidence is the lowest and from case series,case reports and nonrandomized studies.Many studies on the same topic can be combined and analyzed using a method called meta-analysis.This technique collects all studies and carefully analyzes all data and the experimental methods utilized to generate this information.From the acceptable data,an odds ratio (OR) or risk ratio is calculated.If this ratio is 1 and the 95% confidence interval (CI) overlaps 1,there is no difference between the treatment and the control.If the odds ratio is different than 1 (and the confidence interval does not overlap 1,then the treatment is either better (or worse)than the control group.)Example：(1)OR=1.4(95%CI=0.8-1.9)=nor significant.(2)OR=1.4(95%CI=1.2-1.6)=significant.The advantages and disadvantages of this technique will be discussed.Examples will be given from the nutritional literature as to how to use this information in making decisions in the prescription of various types of nutritional support.展开更多
文摘The etabolic response to injury,whether a controlled electivesurgical procedure or an accidental injury,is characterized by the breakdown of skeletal muscle protein and the translocation of the amino acids to visceral organs and the wound.At these sites the substrate serves to dnhance host defenses,and support vital organ function and wound repair.Glutamine (GLN) plays a major role in this process,accounting for approximately one-third of the translocated nitrogen.From the data available,GLN supplemented intravenous nutrition in patients undergoing elective surgery improved nitrogen balance,helped correct the decreased GLN concentration found in the free intracellular skeletal muscle amino acid pool and enhanced net protein synthesis (particularly in skeletal muscel).Six rancomized blinded trials(two multicentered investigations) have reported a dereased length in hospital stay in postoperative patients receiving GLN supplementation.Following blunt trauma,GLN supplementation increased plasma concentrations,attenuated the immunosuppression commonly observed and decreased the rate of infection.Patients with burn injury have low GLN plasma and intramuscular concentrations,but turnover and synthesis rate are accelerated,yet apparently inadequate to support normal concentrations.These data suggests that GLN supplementation has important effects in catabolic surgical patients,but the exact mechanisms to explain these events remain unknown and more research is required to explain the apparent benefits of dietary GLN.
文摘Recent trends suggest that clinicians should use evidencegenerated by sound scientific studies in the treatment of patients.This field of clinical epidemiology has been formalized and is referred to as evidence based medicine.Recommendations from this field urge practitioners to use the best evidence available to make clinical decisions;category A veidence is from large well-performed randomized trials,category B evidence comes from smaller trials or from meta-analysis and category C evidence is the lowest and from case series,case reports and nonrandomized studies.Many studies on the same topic can be combined and analyzed using a method called meta-analysis.This technique collects all studies and carefully analyzes all data and the experimental methods utilized to generate this information.From the acceptable data,an odds ratio (OR) or risk ratio is calculated.If this ratio is 1 and the 95% confidence interval (CI) overlaps 1,there is no difference between the treatment and the control.If the odds ratio is different than 1 (and the confidence interval does not overlap 1,then the treatment is either better (or worse)than the control group.)Example：(1)OR=1.4(95%CI=0.8-1.9)=nor significant.(2)OR=1.4(95%CI=1.2-1.6)=significant.The advantages and disadvantages of this technique will be discussed.Examples will be given from the nutritional literature as to how to use this information in making decisions in the prescription of various types of nutritional support.
